Hair pulling disorders are often discussed in clinical terms, but for some children the behaviour may be shaped as much by culture as by psychology. New research from India highlights how religious observation and family influence can contribute to eyebrow hair loss in a way that closely resembles recognised mental health conditions. The findings were published in Indian Dermatology Online Journal.
The case centres on a 10-year old girl who developed symmetrical eyebrow loss over a short period, prompting concern from her family. Eyebrows play an important role in facial expression and identity, and sudden hair loss in a child can be distressing for both the individual and those around them.
Clinicians initially noted features commonly seen in trichotillomania, a condition linked to anxiety and stress where individuals repeatedly pull out their own hair. Examination of the eyebrows showed uneven hair length and broken hairs, while the scalp remained unaffected. There were no signs of physical illness, scarring, or broader mental health problems, and the child was functioning well at school and at home.
Further assessment revealed a powerful cultural context. The child had grown up observing Jain monks who practise a ritual involving deliberate hair plucking as part of religious devotion. Over time, she began copying this behaviour, gradually adopting eyebrow pulling without distress or awareness of harm. The habit eventually became frequent enough to cause visible hair loss.
Researchers describe this presentation as culturally influenced trichotillomania, sometimes referred to as trichotillosis. While trichotillomania is classified as a body focused repetitive behaviour related to obsessive compulsive disorders, this case shows how cultural learning can shape how such behaviours emerge and are expressed in children.
Importantly, the child did not display anxiety, depression, or other psychiatric symptoms that often accompany hair pulling disorders. This suggests that the behaviour was learned through observation and imitation rather than driven by emotional distress. In this context, hair pulling became normalised within the child’s understanding of discipline, endurance, and religious meaning.
The findings underline the complexity of diagnosing hair loss in young people. Eyebrow loss caused by repeated pulling can closely resemble conditions such as alopecia areata, which has very different causes and treatments. Without careful attention to behavioural patterns and family history, misdiagnosis is possible.
Clinicians involved in the case emphasised the value of culturally sensitive care. Treatment focused on gentle counselling and habit reversal techniques rather than medication or psychiatric intervention. Discussions with the child respected her beliefs while helping her understand the physical consequences of the behaviour and encouraging alternative coping strategies.
Experts say this case highlights a broader issue in child mental health and dermatology. Cultural practices and family modelling can strongly influence behaviour, especially in younger children. When such behaviours overlap with recognised mental health disorders, assessment must go beyond symptoms alone.
The researchers argue that greater awareness of culturally bound behaviours is essential for accurate diagnosis and effective care. By considering cultural background alongside psychological and medical factors, professionals can avoid unnecessary stigma and provide support that is both respectful and effective.